Paradoxical herniation after decompressive craniectomy provoked by mannitol:A case report  

作　　者：Chuan Du Hua-Juan Tang Shuang-Ming Fan 

机构地区：[1]Neurosurgery,the Affiliated Hospital of Chengdu University,Chengdu 610000,Sichuan Province,China [2]Neurology,West China Hospital,Sichuan University,Chengdu 610000,Sichuan Province,China

出　　处：《World Journal of Clinical Cases》2022年第15期4917-4922,共6页世界临床病例杂志

基　　金：Supported by the Natural Science Project of Chengdu University Clinical School,No.2020YYZ18.

摘　　要：BACKGROUND Paradoxical transtentorial herniation is a rare but life-threatening complication of cerebrospinal fluid drainage in patients with large decompressive craniectomy.However,paradoxical transtentorial herniation after rapid intravenous infusion of mannitol has not been reported yet.CASE SUMMARY A 48-year-old male suffered from a right temporal vascular malformation with hemorrhage.In a coma,the patient was given emergency vascular malformation resection,hematoma removal,and the right decompressive craniectomy.The patient woke up on the 1st d after the operation and was given 50 g of 20% mannitol intravenously every 8 h without cerebrospinal fluid drainage.On the morning of the 7th postoperative day,after 50 g of 20% mannitol infusion in the Fowler’s position,the neurological function of the patient continued to deteriorate,and the right pupils dilated to 4 mm and the left to 2 mm.Additionally,computed tomography revealed an increasing midline shift and transtentorial herniation.The patient was placed in a supine position and given 0.9% saline intravenously.A few hours later,the patient was fully awake with purposeful movements on his right side and normal communication.CONCLUSION Paradoxical herniation may occur,although rarely,after infusing high-dose mannitol intravenously in the Fowler’s position in the case of a large craniectomy defect.An attempt should be made to place the patient in the supine position because this simple maneuver may be life-saving.Do not use high-dose mannitol when the flap is severely sunken.

关 键 词：Decompressive craniectomy Intracranial hypotension Paradoxical herniation Transtentorial herniation MANNITOL Case report 

分 类 号：R651.1[医药卫生—外科学]